PROGNOSTIC VALUE OF EARLY COMPUTED TOMOGRAPHIC SCANS IN SEVERE ACUTE-PANCREATITIS

BACKGROUND: The prognostic value of computed tomographic (CT) scans in differentiating mild from severe forms of acute pancreatitis is well established. Nonetheless, in patients with a severe form of the diseas e, some will have a relatively uneventful course while others will hav e severe complications. This prospective, multicenter study was done t o evaluate the prognostic value of early CT scan in a homogenous group of patients with a first attack of severe acute pancreatitis. STUDY D ESIGN: Dynamic CT scans were performed within 48 hours after admission . A standardized form was completed for each CT scan, recording the fo llowing data: abnormal enhancement of the pancreas itself, characteris tics of extrapanceatic collections, and visualization of the portal an d splenic veins. Statistical analysis was based on the log rank test a nd Cox's model and used death and abscess occurrence as the two end po ints. RESULTS: Two hundred twenty-eight patients from 46 centers were included in the study. The median Ranson and Imrie scores were 3 and 4 , respectively. Forty-seven patients died and 72 had an abscess. The C T scan findings indicating an increase in mortality rate were nonenhan cement of the neck of the pancreas (p=0.04) and extrapancreatic collec tions within the left (p=0.001) and right (p=0.02) pararenal posterior spaces. The risk of abscess increased when there was nonvisualization of the splenic vein (p=0.0001), in the presence of extrapancreatic co llections in the right pararenal posterior space (p=0.03) and when the extrapancreatic collections were heterogenous (p=0.003). CONCLUSIONS: This study demonstrated that the location of extrapancreatic collecti ons and nonvisualization of the splenic and portal veins on CT scans w ere not previously recognized prognostic factors of complicated outcom e in patients with severe acute pancreatitis.